Electrical cardioversion

The principal indications for elective cardioversion are persistent atrial fibrillation and atrial flutter. Elective cardioversion is used very rarely in other types of arrhythmia since immediate rhythm management is usually indicated.
When the arrhythmia causes such haemodynamic instability that a transfer of the patient to a hospital cannot be considered safe, and pharmacological management is not an option, cardioversion should be carried out without delay, even if the patient is not receiving therapeutic anticoagulation or has just eaten.